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Monthly Archives: December 2009

Evidence-based practice (whether in management, education, medicine or other) describes a process designed to facilitate an integrative and evaluative judgement, based on empirical evidence and theoretical rationale, as to the appropriateness and adequacy of actions or proposed actions, that are based on the processes or protocols of a practice or program.

Anyone familiar with the validity theory of Samuel Messick will recognize that this is drawn from his language. That is because of my belief that the evidence-based movement should focus on practice in a way that can best be understood as practice validity (or process validity, or program validity depending on your perspective and task)

Evidence-based practice represents a multifaceted judgment. This is not a cookbook or a cherry picking approach. It is a multifaceted judgement integrating all relevant information to evaluate actions as to their appropriateness for specific contexts and goals. These actions are based on empirically supported theoretical rationales that are also backed up by locally collected data.

Evidence-based practice is scientific inquiry. This approach does not just rely on the results of scientific inquiry, it represents a form of scientific inquiry, but instead of being directed toward some aspect of theory (an a-contextual methodology), it is directed toward a specific practice (a contextualized methodology). Though much of the literature equates an evidence-based approach with a decision-making process, the application of evidence is often focused on processes (or standing practices, or programs) and whether these processes are adequate and appropriate toward intended goals.

Evidence-based Practice should be associated with valid clinical or practice judgment. A common criticism of the cookbook approach to EBP is that it impinges upon the ability of clinicians to make clinical judgements, but that is only true if one does not recognize that EBP is itself a judgement. It is a form of clinical judgement and should occupy an important space within clinical practice. This is an important point because research information seldom exactly fits the contexts of practice. Applying this type of information is not direct, but requires making an informed judgment. This is also an area that needs additional study. I don’t believe that we really fully understand all aspects (especially cognitive aspects) of clinical judgment.